Fast Facts

As the U.S. population ages, demand will increase for home- and community-based services that help older adults stay in their homes. But meeting this demand may be difficult, especially in rural areas.

For instance, rural older adults may have:

Less access to certain services, such as home-delivered meals

Longer travel distances for health care, groceries, and support services—with fewer transportation options

Fewer available caregivers due, in part, to a dwindling working-age population in rural areas

We recommended centralizing information on promising practices to help local agencies and providers better serve rural older adults.

Volunteer Delivering a Week's Worth of Meals in Rural Maine

Volunteer walking up steps to a home carrying a bag with meals for an older adult.

Volunteer walking up steps to a home carrying a bag with meals for an older adult.

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Highlights

Why This Matters

Rural areas cover the vast majority of the country and tend to be “grayer” than urban areas, with higher percentages of older adults. Many older adults prefer to stay in their homes as they age, but it can be difficult to connect rural older adults to needed services.

Key Takeaways

To stay in their homes as they age, older adults often need services such as in-home care, meal delivery, and transportation to medical appointments. Under the Older Americans Act of 1965, the Department of Health and Human Services (HHS) funds grants to help state and local agencies provide these services. Rural older adults are identified as important service recipients because of their economic and social needs.

However, studies indicate that rural older adults received certain services, such as home-delivered meals, less frequently than urban older adults. Local officials and service providers told us how reaching older adults in remote, sparsely populated areas can add to the cost and effort of providing services, and how a dwindling working-age population can mean fewer caregivers and volunteers to help.

HHS supports over two dozen national resource centers that publish information on promising practices for delivering services to older adults, including some that may be useful for rural agencies. Yet this information is spread across national resource center websites and is not centrally accessible. Local officials were often not aware of pertinent resources. Several said that more information on rural promising practices or other resources would be helpful.

Rural and Urban Population Aged 65 and Older, by County

Rural and Urban Population Aged 65 and Older, by County

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Recommendations

HHS should centralize access to and promote awareness of promising practices or other useful information pertinent to serving rural older adults. HHS agreed.

How GAO Did This Study

We analyzed 2017 HHS survey data; reviewed relevant federal laws, agency documents, and studies; and interviewed service providers in 12 rural localities in eight states. We also interviewed HHS officials, national associations, and experts on rural issues.

Recommendations for Executive Action

Agency Affected Recommendation Status
Administration for Community Living The Administrator of ACL should take steps to better centralize access to and promote awareness of information on promising practices or other useful information pertinent to serving rural older adults.
Closed - Implemented
HHS agreed with this recommendation and ACL has taken several steps to centralize access and promote awareness of relevant information pertinent to serving rural older adults. In terms of centralizing access, ACL stated that a technology solution that would allow users to search across ACL-funded resource centers, which are operated by separate grantees and contractors, would be technically challenging and not feasible with existing funding and resources. As an alternative, ACL has communicated to its resource center grantees to take steps to enable information relevant to serving rural older adults to be easily identifiable on their websites. Recent examples of information relevant to serving rural older adults among ACL's resource centers include The National Center on Law & Elder Rights' "Tools for Addressing Elder Financial Exploitation in Rural Areas" and the National Resource Center on Nutrition and Aging's toolkit on "Addressing Nutrition and Social Connection Needs of Rural Older Adults During the COVID-19 Emergency." ACL has also included in its resource center grant announcements an expectation that centers identify promising practices that ensure the needs of underserved populations, such as rural populations, are supported. In terms of promoting awareness of relevant information, ACL has made it easier to find ACL-funded resource centers on its website, by linking the list of these centers in multiple parts of the ACL website. Additionally, ACL posted a blog in November 2020 for National Rural Health Day that highlighted information on health and human services resources for rural older adults and people with disabilities.

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